Foi feito um estudo de revisão sobre a mortalidade na fratura do fêmur proximal em idosos com base nas publicações mais relevantes do período de 1998 a 2002. Foram incluídos 25 artigos relacionados ao assunto, selecionados com base nos bancos de dados Medline e Cochrane, totalizando 24.062 pacientes com mais de 60 anos de idade, que tiveram fratura do fêmur proximal. Quatorze estudos foram prospectivos, oito retrospectivos e três revisões sistemáticas. As taxas médias de mortalidade foram de 5,5% durante a internação hospitalar, 4,7% ao fim de um mês de seguimento, 11,9% com três meses, 10,8% com seis meses, 19,2% com um ano e 24,9% com dois anos. Foram identificados quatro fatores intimamente relacionados com uma maior mortalidade nestes pacientes: idade avançada, grande número de doenças associadas, sexo masculino e presença de deficiências cognitivas. Outros fatores mostraram uma fraca correlação com a mortalidade como capacidade deambulatória prévia, índice de risco anestésico da Sociedade Americana de Anestesia (ASA), anemia, hipoalbuminemia, linfopenia e existência de AVC prévio. Os fatores como tempo prévio à cirurgia, tipo de anestesia utilizada e tipo de osteossíntese empregada não mostraram ter interferência.

Laparoscopic liver resection (LLR) has been progressively developed along the past two decades. Despite initial skepticism, improved operative results made laparoscopic approach incorporated to surgical practice and operations increased in frequency and complexity. Evidence supporting LLR comes from case-series, comparative studies and meta-analysis. Despite lack of level 1 evidence, the body of literature is stronger and existing data confirms the safety, feasibility and benefits of laparoscopic approach when compared to open resection. Indications for LLR do not differ from those for open surgery. They include benign and malignant (both primary and metastatic) tumors and living donor liver harvesting. Currently, resection of lesions located on anterolateral segments and left lateral sectionectomy are performed systematically by laparoscopy in hepatobiliary specialized centers. Resection of lesions located on posterosuperior segments (1, 4a, 7, 8) and major liver resections were shown to be feasible but remain technically demanding procedures, which should be reserved to experienced surgeons. Hand-assisted and laparoscopy-assisted procedures appeared to increase the indications of minimally invasive liver surgery and are useful strategies applied to difficult and major resections. LLR proved to be safe for malignant lesions and offers some short-term advantages over open resection. Oncological results including resection margin status and long-term survival were not inferior to open resection. At present, surgical community expects high quality studies to base the already perceived better outcomes achieved by laparoscopy in major centers' practice. Continuous surgical training, as well as new technologies should augment the application of laparoscopic liver surgery. Future applicability of new technologies such as robot assistance and image-guided surgery is still under investigation.

for the International Robotic and Laparoscopic Liver Resection study group investigators IMPORTANCE Laparoscopic and robotic techniques have both been well adopted as safe options in selected patients undergoing hepatectomy. However, it is unknown whether either approach is superior, especially for major hepatectomy such as right hepatectomy or extended right hepatectomy (RH/ERH). OBJECTIVETo compare the outcomes of robotic vs laparoscopic RH/ERH. DESIGN, SETTING, AND PARTICIPANTS In this case-control study, propensity score matching analysis was performed to minimize selection bias. Patients undergoing robotic or laparoscopic RH/EHR at 29 international centers from 2008 to 2020 were included. INTERVENTIONS Robotic vs laparoscopic RH/ERH. MAIN OUTCOMES AND MEASURES Data on patient demographics, tumor characteristics, and short-term perioperative outcomes were collected and analyzed. RESULTS Of 989 individuals who met study criteria, 220 underwent robotic and 769 underwent laparoscopic surgery. The median (IQR) age in the robotic RH/ERH group was 61.00 (51.86-69.00) years and in the laparoscopic RH/ERH group was 62.00 (52.03-70.00) years. Propensity score matching resulted in 220 matched pairs for further analysis. Patients' demographics and tumor characteristics were comparable in the matched cohorts. Robotic RH/ERH was associated with a lower open conversion rate (19 of 220 [8.6%] vs 39 of 220 [17.1%]; P = .01) and a shorter postoperative hospital stay (median [IQR], 7.

No abstract

No abstract